Spirituality and health: the doctor as clergyman

Tomorrow, I have the unenviable task of teaching the first year medical students at our institution how to do a spiritual assessment. To answer the reader’s next question, no, I did not recently switch professions. I did not have an early-mid life crisis and leave medicine in order to pursue a life of poverty and a degree in divinity. Apparently, taking a spiritual assessment is part of medicine! Who knew? In fact, the Association of American Medical Colleges – the body in charge of accrediting American medical schools – actually requires that this be part of the medical school curriculum! Somehow I managed to graduate without learning this incredibly important medical skill!

Here’s one tool for taking a spiritual assessment, developed by doctor named, Puchalski:

F – faith, belief, meaning: Do you consider yourself spiritual or religious? Do you have beliefs that help you cope with stress? What gives your life meaning?
I – importance, influence: What importance does faith have in your life? Do you have specific beliefs that might influence your healthcare decisions?
C – community: Are you part of a religious community? Is this a source of support?
A – address/action in care: How should the healthcare provider address these issues?

I have never done a spiritual assessment in a clinical situation, nor do I ever plan to. In general, whenever I make bold or controversial statements, I try to provide some argument. The position, however, that discussions of religion/spirituality have no place within the context of the doctor-patient relationship, I consider to be neither bold nor controversial. Doctors get paid the big bucks to provide treatment and to help patients make medical decisions. Could someone’s faith influence their medical decision making? Sure. So what? Is there ever a situation in which I would counsel a patient differently, treat them differently or recommend different treatment based on their spiritual religious beliefs? Absolutely not. Never. In no situation is it ever necessary or even preferable to know what a patient’s religion is, indeed whether or not they have religion/spirituality in their lives at all, in order to provide effective medical care.
Eliciting a patients preference with regard their medical treatment, on the other hand, is often of critical importance. But there’s no need for your doctor to know what’s influencing those preferences. Your preferences are your preferences and where they come from is between you and you and, perhaps, God.